Incidence of Rib Fracture following Treatment with Proton Therapy for Breast Cancer.

Julie A Bradley, Xiaoying Liang, Raymond B Mailhot Vega, Chunbo Liu, Eric D Brooks, Teena Burchianti, Emma Viviers, Roi Dagan, Oluwadamilola T Oladeru, Christopher G Morris, Nancy P Mendenhall
{"title":"Incidence of Rib Fracture following Treatment with Proton Therapy for Breast Cancer.","authors":"Julie A Bradley,&nbsp;Xiaoying Liang,&nbsp;Raymond B Mailhot Vega,&nbsp;Chunbo Liu,&nbsp;Eric D Brooks,&nbsp;Teena Burchianti,&nbsp;Emma Viviers,&nbsp;Roi Dagan,&nbsp;Oluwadamilola T Oladeru,&nbsp;Christopher G Morris,&nbsp;Nancy P Mendenhall","doi":"10.14338/IJPT-22-00034.1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To determine the rib fracture rate in a cohort of patients with breast cancer treated with proton therapy.</p><p><strong>Patient and methods: </strong>From a prospective database, we identified 225 patients treated with proton therapy between 2012 and 2020 (223 women; 2 men). Clinical and dosimetric data were extracted, the cumulative incidence method assessed rib fracture rate, and Fine-Gray tests assessed prognostic significance of select variables. In-field rib fracture was defined as a fracture that occurred in a rib located within the 10% isodose line. Out-of-field rib fracture was defined as a fracture occurring in a rib location outside of the 10% isodose line.</p><p><strong>Results: </strong>Of the patients, 74% had left-sided breast cancer; 5%, bilateral; and 21%, right-sided. Dual-energy x-ray absorptiometry scans showed normality in 20%, osteopenia in 34%, and osteoporosis in 6% (test not performed in 40%). Additionally, 57% received an aromatase inhibitor. Target volumes were breast ± internal mammary nodes (IMNs) (16%), breast and comprehensive regional lymphatics (32%), chest wall ± IMNs (1%), and chest wall/comprehensive regional lymphatics (51%). Passive-scattered proton therapy was used for 41% of patients, 58% underwent pencil-beam scanning (PBS), and 1% underwent a combination (passive scattering/PBS), with 85% of patients receiving a boost. Median follow-up was 3.1 years, with 97% having >12-month follow-up. The 3-year cumulative in-field rib fracture incidence was 3.7%. Eight patients developed in-field rib fractures (1 symptomatic, 7 imaging identified) for a 0.4% symptomatic rib fracture rate. Median time from radiation completion to rib fracture identification was 1.8 years (fractures were identified within 2.2 years for 7 of 8 patients). No variables were associated with rib fracture on univariate analysis. Three fractures developed outside the radiation field (0.9% cumulative incidence of out-of-field rib fracture).</p><p><strong>Conclusion: </strong>In this series of patients with breast cancer treated with proton therapy, the 3-year rib fracture rates remain low (in-field 3.7%; symptomatic 0.4%). As in photon therapy, the asymptomatic rate may be underestimated owing to a lack of routine surveillance imaging. However, patients experiencing symptomatic rib fractures after proton therapy for breast cancer are rare.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 4","pages":"269-278"},"PeriodicalIF":2.1000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166011/pdf/","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Particle Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14338/IJPT-22-00034.1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 2

Abstract

Purpose: To determine the rib fracture rate in a cohort of patients with breast cancer treated with proton therapy.

Patient and methods: From a prospective database, we identified 225 patients treated with proton therapy between 2012 and 2020 (223 women; 2 men). Clinical and dosimetric data were extracted, the cumulative incidence method assessed rib fracture rate, and Fine-Gray tests assessed prognostic significance of select variables. In-field rib fracture was defined as a fracture that occurred in a rib located within the 10% isodose line. Out-of-field rib fracture was defined as a fracture occurring in a rib location outside of the 10% isodose line.

Results: Of the patients, 74% had left-sided breast cancer; 5%, bilateral; and 21%, right-sided. Dual-energy x-ray absorptiometry scans showed normality in 20%, osteopenia in 34%, and osteoporosis in 6% (test not performed in 40%). Additionally, 57% received an aromatase inhibitor. Target volumes were breast ± internal mammary nodes (IMNs) (16%), breast and comprehensive regional lymphatics (32%), chest wall ± IMNs (1%), and chest wall/comprehensive regional lymphatics (51%). Passive-scattered proton therapy was used for 41% of patients, 58% underwent pencil-beam scanning (PBS), and 1% underwent a combination (passive scattering/PBS), with 85% of patients receiving a boost. Median follow-up was 3.1 years, with 97% having >12-month follow-up. The 3-year cumulative in-field rib fracture incidence was 3.7%. Eight patients developed in-field rib fractures (1 symptomatic, 7 imaging identified) for a 0.4% symptomatic rib fracture rate. Median time from radiation completion to rib fracture identification was 1.8 years (fractures were identified within 2.2 years for 7 of 8 patients). No variables were associated with rib fracture on univariate analysis. Three fractures developed outside the radiation field (0.9% cumulative incidence of out-of-field rib fracture).

Conclusion: In this series of patients with breast cancer treated with proton therapy, the 3-year rib fracture rates remain low (in-field 3.7%; symptomatic 0.4%). As in photon therapy, the asymptomatic rate may be underestimated owing to a lack of routine surveillance imaging. However, patients experiencing symptomatic rib fractures after proton therapy for breast cancer are rare.

Abstract Image

Abstract Image

Abstract Image

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
乳癌质子治疗后肋骨骨折的发生率。
目的:了解一组接受质子治疗的乳腺癌患者肋骨骨折的发生率。患者和方法:从前瞻性数据库中,我们确定了2012年至2020年间接受质子治疗的225例患者(223名女性;2人)。提取临床和剂量学数据,累积发生率法评估肋骨骨折率,Fine-Gray试验评估选定变量的预后意义。现场肋骨骨折被定义为发生在10%等剂量线内的肋骨骨折。外场肋骨骨折被定义为发生在10%等剂量线以外的肋骨位置的骨折。结果:74%的患者患有左侧乳腺癌;5%,两国;右边21%。双能x线吸收仪扫描显示20%正常,34%骨质减少,6%骨质疏松(40%未做检查)。此外,57%的患者接受了芳香酶抑制剂治疗。靶体积为乳腺±乳腺内淋巴结(IMNs)(16%)、乳腺及综合区域淋巴管(32%)、胸壁±IMNs(1%)和胸壁/综合区域淋巴管(51%)。41%的患者接受了被动散射质子治疗,58%的患者接受了铅笔束扫描(PBS), 1%的患者接受了联合治疗(被动散射/PBS), 85%的患者接受了增强治疗。中位随访时间为3.1年,97%随访时间大于12个月。3年累计现场肋骨骨折发生率为3.7%。8例患者发生现场肋骨骨折(1例有症状,7例影像学发现),症状性肋骨骨折率为0.4%。从放疗完成到发现肋骨骨折的中位时间为1.8年(8例患者中有7例在2.2年内发现骨折)。在单因素分析中,没有变量与肋骨骨折相关。3例骨折发生在辐射场外(累计发生率为0.9%)。结论:在这组接受质子治疗的乳腺癌患者中,3年肋骨骨折发生率仍然很低(现场3.7%;有症状的0.4%)。在光子治疗中,由于缺乏常规监测成像,无症状率可能被低估。然而,乳腺癌质子治疗后出现症状性肋骨骨折的患者是罕见的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
Impact of COVID-19 Pandemic on Carbon-Ion Radiation Therapy in Japan: A Japanese National Registry Study. Vaginal Mucosal Melanoma Cell Activation in Response to Photon or Carbon Ion Irradiation. Navigating a New Frontier: Evaluating Leadless Pacemakers in Proton Therapy. Cardiac Conduction System as an OAR in Radiation Therapy: Doses to SA/AV Nodes and Their Reduction. Value of Carbon-Ion Radiation Therapy for Breast Cancer.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1